The Hospital Authority (“HA”) has implemented the Drug Formulary (“the Formulary”) since 2005 with a view to ensuring equitable access by patients to cost-effective drugs of proven safety and efficacy through standardization of policies on drugs and drug utilization. At present, there are four categories of drugs in the HA Drug Formulary:
These are drugs with well-established indications and cost- effectiveness which are available for general use as indicated by patients with relevant clinical conditions and provided at standard fees and charges in public hospitals and clinics.
These are drugs used under specific clinical conditions with specific specialist authorisation. Special drugs are provided at standard fees and charges in public hospitals and clinics when prescribed under specific clinical conditions. Patients who do not meet the specified clinical conditions but choose to use Special drugs are required to pay for the drugs.
Self-financed Items (SFIs) with Safety Net
These are drugs which are proven to be of significant clinical benefits but are very expensive for HA to provide as part of its standard services. These drugs are not covered by the standard fees and charges in public hospitals and clinics. Patients who require these drugs and can afford the costs have to purchase the drugs at their own expense. A safety net is provided through relevant funds to subsidize the drug expenses of patients who have financial difficulties.
SFIs without Safety Net
These include drugs with preliminary medical evidence only, drugs with marginal benefits over available alternatives but at significant higher costs, and lifestyle drugs (e.g. anti-obesity drugs). These drugs are not provided as part of HA’s standard services nor covered by the standard fees and charges in public hospitals and clinics. Patients who choose to use these drugs must purchase them at their own expense.
The Drug Formulary is developed by on‐going evaluation of new drugs and regular review of the prevailing list of drugs by relevant committees under established mechanisms.
- Drug Management Committee (DMC) is responsible for HA’s overall drug management.
- Drug Advisory Committee (DAC) is responsible for regular evaluation of new drugs and new indications for listing on the HA Drug Formulary.
- Drug Formulary Committee (DFC) is tasked to review the current drug list in the HA Drug Formulary biennially in order to remove obsolete drugs and modify the clinical indications of individual Special drugs as appropriate. Ad hoc review is also conducted in situations where an alert issued by a health authority indicates a potential impact on change in clinical practice.
- Multiple Expert Panels provide professional support for the above committees.
The evaluation and review processes follow an evidence‐based approach, having regard to the three principal considerations of safety, efficacy and cost‐effectiveness while taking into account other relevant factors, including international recommendations and practices, advance in technology, disease state, patient compliance, quality of life, actual experience in the use of drugs as well as views of professionals and patient groups.
To enhance the transparency of the HA Drug Formulary and partnership with the community, HA convenes two consultation meetings with patient groups every year, one in the second quarter of each year to keep them abreast of the latest developments of the HA Drug Formulary and other in the fourth quarter to gather their major concerns, feedback and wish list on the HA Drug Formulary for annual planning consideration. Patient groups are invited to attend meetings and submit their views and proposals to the HA for reference of relevant drug committees. In addition, with the establishment of the Patient Advisory Committee in early 2011, the Chief Executive of the HA meets patient representatives regularly to collect their views in various areas of patient services, including the HA Drug Formulary. Ad hoc meetings are also convened with individual patient groups to discuss specific issues of concerns where necessary.
The HA Drug Formulary is updated every three months to incorporate changes endorsed by relevant committees under established mechanisms, including addition of new drugs and indications and changes in drug category arising from funded programmes as well as biennial comprehensive and ad hoc review. To enhance the transparency of the decision-making process for including new drugs in the HA Drug Formulary and improve the communication with patient groups, HA would also upload the drug lists discussed at each DAC meeting, the review outcome of each application and the reference materials used in new drug appraisals to the internet website for stakeholders’ reference.
HA will keep on reviewing the HA Drug Formulary in accordance with the principle of rational use of limited public resources to benefit more patients and with reference to the latest developments in clinical research and scientific evidence.